The Last Cell Block

#LASTCELLBLOCK

End of Life Care in Prisons

#lastcellblock

My policy action plan is to advocate for an all-inmate volunteer hospice program in prisons

What is hospice??• Comfort for patients when a life-limiting illness no

longer response to treatment

• It does not prolong life or accelerates death

• It is a team oriented group of specially trained

professionals, volunteers, and family members.

• Improve the quality of a patients’ last days by

offering comfort and dignity

Hospice careAn estimated 1.6 million patients have received hospice services in 2012. This includes: Patients who have died during hospice care Patients who continued care in 2012 from the previous year Patients who left hospice for reasons including prognosis

changes and other reasons that include “live discharges” On average hospice patients care for less than three weeks

with a median length of services was 18.7 days

Hospice Care84% of hospice patients are older than 65.

89% of Medicare Hospice Benefit

4.4% Private Insurance

4.3% Medicaid Hospice Benefit

1.4 % Charity Care and other payment source

0.9% Self pay

There are 4 levels of Hospice care services :

o Routine Home Care 96.5%

o General Inpatient Care 2.7%

o Continuous Care 0.5%

o Respite Care 0.3%

According the United States Justice Department’s

Bureau of Justice Statistics, the general prison

population has grown from 319,000 in 1980 to 1.5

million in 2005.

1978 1988 1998 2008 20120

100000

200000

300000

400000

500000

600000

700000

800000

Federal State

Sentenced state and federal prison admissions from 1978-2012

Violent 45%

Property25%

Drug23%

Public Order7%

Other0%

1991

Vio-lent ; 54%

Property; 19%

Drugs; 17%

Public order; 11%

other; 1%

Offenses under state jurisdictions

2011

Aging prison populationDefining who is “elderly”

• U.S. Census Bureau defines the general elderly population as 65

and older.

• However, the National Commission on Correctional Health Care uses age 55 as the threshold with certain states using 50 as the cut off.

1995 2003 2011

45-54 108100 190900 289034

55 or older 32600 60300 121456

25,000

125,000

225,000

Elderly prison population

U.S. Department of Justice, Bureau of Justice Statistics

“Prisoners commonly experience accelerated aging and have physiological ages equivalent to individuals in the community who are 10 to 15 years older “ (Loeb et al. 2008; Beckett et al. 2003).

Health issues:

Elderly prisons may be at higher risk of violence from other inmates

High chronic stress

Chronic conditions

Infectious diseases

General and prison population health in 2011-12

Chronic conditions Infectious Disease HIV/AIDS0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

44%

21%

1%

31%

5%

1%

Prisoners General population

WhyTo address end of life care for our aging prison population

How Legislative action at the Federal level

When A timeline of 5 years to double the current amount of inmate volunteer hospice programs

Prison hospice programs have the same goals found in community based hospice programs.

The National Prison Hospice Associations recommends using the Interdisciplinary Teams (IDT) consisting of a physician, nurse, mental health representatives, chaplains as well volunteer inmate care givers.

In 1987, Fleet Maull co-founded the first prison hospice

program at the U.S. Medical Center for Federal Prisoners in

Springfield, Missouri.

He is also the co-founder and board of director of The National Prison Hospice Association.

The Principles components of prison hospice care:1. Hospice care in prison –adjustment of hospice to the prison

environment

2. Multidisciplinary team –Nurses, physicians, psychologist, social workers, clergy members, and security officials

3. Inmate volunteer involvement – selection process for suitable inmates. Screening of suitable inmates. Training of volunteers inmates as an additional or regular job.

4. Comfort care- counseling of dying inmates. Contacting the dying patient’s family.

5. End-of-life-care DNR requirements.

(Yampolskaya, S., & Winston, N., 2003).

There are an estimated 75 state and federal prisons that offer some form of hospice care.

Inmate volunteer must meet certain criteria and go through a selection process.

Volunteers must have at least 13 to 24 months left on the sentence term.

Inmate caregivers duties include assisting in activities of daily living (ADL-bathing, feeding, grooming, etc.) and spiritual support

Inmates with a prior conviction for sexual offense are not eligible.

• Cost-effectivenessHospice care in the

prisonMultidisciplinary team

• Corrections BenefitsAll inmate volunteer hospice program

• Experience of Comfort careComfort CareEnd-of-life Care

Beneficial Outcomes :

H.R. 1699: Federal Prison Industries Competition in Contracting Act 2015Sec. 10. Providing additional rehabilitative opportunities.

4124a. Additional inmate work opportunities through public service activities—

There is hereby established the position of Inmate Work Training Administrator, who shall be responsible for fostering the creation of alternative inmate work opportunities authorized by this section. The Administrator shall be designated by the Chief Executive Officer of Federal Prison Industries, with the approval of the Board of Directors, and be under the supervision of the Chief Operating Officer, but may directly report to the Board.1) On or before, five years after the effective date of this subsection, (1) the state and federal corrections centers are to address the elderly prison population, with proper end of life care. An all-inmate volunteer hospice programs are to be implemented. This program will provide an alternative work experience, as well rehabilitative opportunities, to better prepare inmates for a successful return to society..

Bill Huizenga (R) U.S. Representative for Michigan’s 2nd congressional district. He introduced H.R. 1699 before the House Judiciary. Committee on Financial Services

Carolyn Maloney (D) U.S. Representative for New York’s 12th congressional district. Committee on Oversight and Government Reform. Co-sponsored H.R. 1699

Policy Paramours

Policy Paramours

Karen Bass (D) U.S. Representative for California 37th congressional district. Committee of the Judiciary

Bob Goodlatte (R) U.S. Representative for Virginia’s 6th congressional district. He is the Chairman on the Committee of the Judiciary.

Governmental Stakeholders

The United States Department of Justice Federal Bureau of PrisonsThe United States Drug Enforcement AdministrationThe Federal Protective ServicesU.S. National Central Bureau - Interpol (Justice Department)U.S. Sentencing CommissionHealth Resources and Services Administration

Non-Governmental Stake Holders

National Prison Hospice AssociationNational Hospice and Palliative Care OrganizationHospice Foundation of AmericaAmerican Civil Liberties UnionThe Center for Prisoner Health and Human RightsHuman Rights Watch

2012, NHPCO National Data Set and/or NHPCO Member Database.

1st Quarter 2012, Centers for Medicare and Medicaid Services (CMS) Provider of Service File (POS).

Bureau of Prisons. (2011). About the Federal Bureau of Prisons. Washington, DC: US Department of Justice.

Hoyert DL, Xu J,. Deaths: Preliminary Data for 2011, National Vital Statistics Reports, vol 61 no 6. National Center for Health Statistics, CDC, available online at: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf.

Murphy SL, Xu J, Kochanek KD. Final Data for 2010, National Vital Statistics Reports, vol 61 no 4. National Center for Health Statistics, 2013

Miller SC, Lima J, Gozalo PL, Mor V. Th e Growth of Hospice Care in U.S. Nursing Homes. JAGS. 2010 58:1481-88

U.S. Department of Justice Office of Justice Programs Bureau of Justice StatisticsYampolskaya, S., & Winston, N. (2003). Hospice care in prison: General principles and outcomes. American Journal of Hospice and Palliative Care, 20(4), 290-296. doi:10.1177/104990910302000411

References